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Building a Warehouse

July 23, 2008
by Daphne Lawrence
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CIOs are finding that while a warehouse is the end game, data marts make the ride more productive

Patricia salem

Patricia Salem

Dashboards are a hot topic on CIOs' current to-do list — hospitals either want them or are working on developing them. Why? The need for immediately actionable data is more intense than ever, and growing daily, as hospital and health system executives seek to analyze and optimize operational performance in real-time. But that's easier said than done, as hospitals can have hundreds of data silos. Before an IT team can even get to the dashboard, it's got to do a lot of plumbing. Or, as Patricia Salem, vice president of Healthcare Planning and Business Intelligence at Golden Consulting (Bloomfield, Conn.) puts it, “You've got to get the information under control.”

Why the sudden push? With pay-for-performance initiatives expanding, hospitals are scrambling for tools to put information into useful, actionable formats. Naturally, the pressure falls on CIOs and their IT teams. “Hospitals are going crazy,” says Salem. “They're trying to run reports, respond to users for reports, and business users are sending report requests to IT. IT can't keep up.”

Mike davis

Mike Davis

Increased demand is also arising out of the rapid growth of the EMR, and the new availability of information in electronic format. There's also the manual problem of printing, copying and mailing reports.

So if dashboards are in such demand, why the slow adoption? The general problem has been the lack of data warehouses in hospitals. But smart CIOs are beginning to see that dashboards can be utilized even without them, and they're experimenting with a variety of dashboard solutions, either homegrown or Web-based.

Dashboards — in the form of executive information systems (EIS) — go back around 15 years; most early versions focused on financial performance. “The intent was to create a high level overview of key performances indicators: adjusted patient days and discharges, readmissions within 24 hours, and all the things that have an impact on operations or reimbursements,” says Mike Davis, vice president of Chicago-based HIMSS Analytics. Many hospitals began creating Web-based dashboards to look at specific data elements or reports created in other systems. “You can do that,” says Davis. “The issue is you're only looking at data from one environment.”

The dashboards were also useful in aligning the strategic goals of an organization on a monthly or quarterly basis, often to report to the board — a “how are we doing” overview. Those often included indicators like patient and employee satisfaction data.

The challenge was information aggregation from disparate sources. “Keeping these environments in sync was problematic, with a lot of overhead,” says Davis. “It was an interoperability nightmare. And the data might not have been as accurate as (people) thought it was.”

Most agree that a data repository is the answer. “You can do it where you map directly into applications,” says Davis, “but all you basically get are the reports from those applications. And a lot of this stuff is going to be retrospective.”

That's not always the worst thing in the world. According to Davis, retrospective information is usually good enough for the C-suite. “When I come in at 8 in the morning, I want to see a snapshot of what happened yesterday,” he says.

Today, most hospitals are still not sophisticated enough to correlate financial and clinical information, especially in real time. The exceptions are the larger academic and community hospitals and multi-hospital integrated systems that have developed the one aforementioned tool that makes it possible — the data warehouse.

Still, progress is being made industry-wide, observers note. “A lot of hospitals are undergoing huge data warehousing projects,” says Salem. “Many hospitals have the long-term vision of dashboards, but it takes years to get the process in place, get the warehouse together and internally work with business users in different departments to find out the key reporting metrics and data sources. This technology has been very expensive, and the community medical centers couldn't even look at it due to the cost.”

So in the absence of a data warehouse, what can a CIO do in the interim?

Rick schooner

Rick Schooler

The good news, says Davis, is that Web tools with reporting services can sometimes be used in lieu of a true data warehouse. He says the newer business intelligence products do a better job of capturing information from diverse environments. “When you look at self-developed (solutions), that's what people are doing,” he says. “These are very focused data marts that gather and capture information to put into whatever algorithms you want to track key-performance indicators. Visually, they're very appealing.”

That's what Rick Schooler, CIO of Orlando Health (Orlando, Fla.) is doing; although, he says, a true business intelligence platform is definitely part of his long-term strategic plan. His tactics might sound familiar to many CIOs. “We do not yet have what we would consider an enterprise data warehouse,” he says. “We have what I would call data marts that are more focused on particular types of information, or they're a drill-down tool.”